Chickenpox Recurrence: Rare but Possible in Immunocompromised

Second episodes of varicella (chickenpox) are uncommon but documented, primarily in:

• Immunocompromised hosts (HIV, transplant, chemotherapy, steroids)
• Individuals with inadequate primary antibody response
• Those whose initial infection was very mild/subclinical

Clinical Features of Reinfection

• Often milder: fewer vesicles, lower fever, shorter course.
• Can be severe/disseminated in profoundly immunocompromised.
• May present atypically (hemorrhagic, bullous, visceral involvement).

Prevention & Management

• Varicella-zoster immune globulin (VariZIG) post-exposure for high-risk.
• Antivirals (acyclovir/valacyclovir) early in course.
• Two-dose varicella vaccine series for non-immune immunocompetent persons.
• Shingrix (recombinant zoster vaccine) for ≥50 or ≥19 immunocompromised – prevents reactivation (shingles), not primary varicella.

If you suspect recurrent chickenpox, contact your provider promptly for antiviral consideration.